Urine YKL-40 is associated with progressive acute kidney injury or death in hospitalized patients

被引:35
|
作者
Hall, Isaac E. [1 ,2 ]
Stern, Edward P. [3 ]
Cantley, Lloyd G. [1 ]
Elias, Jack A. [4 ]
Parikh, Chirag R. [1 ,2 ]
机构
[1] Yale Univ, Sch Med, Dept Internal Med, Nephrol Sect, New Haven, CT 06510 USA
[2] Yale Univ, Sch Med, Program Appl Translat Res, New Haven, CT 06510 USA
[3] Royal Free London NHS Fdn Trust, Ctr Nephrol, Univ Coll London, London, England
[4] Brown Univ, Div Biol & Med, Providence, RI 02912 USA
来源
BMC NEPHROLOGY | 2014年 / 15卷
基金
美国国家卫生研究院;
关键词
Acute kidney injury; Biomarker; BRP-39; Chitinase; 3-like-1; Net reclassification improvement; YKL-40; CLINICAL-APPLICATIONS; CARDIAC-SURGERY; POOR OUTCOMES; BIOMARKERS; AKI; METAANALYSIS; DIALYSIS; MARKERS; DISEASE; VALUES;
D O I
10.1186/1471-2369-15-133
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: A translational study in renal transplantation suggested YKL-40, a chitinase 3-like-1 gene product, plays an important role in acute kidney injury (AKI) and repair, but data are lacking about this protein in urine from native human kidneys. Methods: This is an ancillary study to a single-center, prospective observational cohort of patients with clinically-defined AKI according to AKI Network serum creatinine criteria. We determined the association of YKL -40 >= 5 ng/ml, alone or combined with neutrophil gelatinase-associated lipocalin (NGAL), in urine collected on the first day of AKI with a clinically important composite outcome (progression to higher AKI stage and/or in-hospital death). Results: YKL-40 was detectable in all 249 patients, but urinary concentrations were considerably lower than in previously measured deceased-donor kidney transplant recipients. Seventy-two patients (29%) progressed or died in-hospital, and YKL-40 >= 5 ng/ml had an adjusted odds ratio (95% confidence interval) for the outcome of 3.4 (1.5-7.7). The addition of YKL-40 to a clinical model for predicting the outcome resulted in a continuous net reclassification improvement of 29% (P = 0.04). In patients at high risk for the outcome based on NGAL concentrations in the upper quartile, YKL-40 further partitioned the cohort into moderate-risk and very high-risk groups. Conclusions: Urine YKL-40 is associated with AKI progression and/or death in hospitalized patients and improves clinically determined risk reclassification. Combining YKL-40 with other AKI biomarkers like NGAL may further delineate progression risk, though additional studies are needed to determine whether YKL-40 has general applicability and to define its association with longer-term outcomes in AKI.
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页数:9
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